Brachioradial Pruritus Clinical Presentation

  • Author: Julianne Mann, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Aug 12, 2016
 

History

The itch of brachioradial pruritus is described as intense, burning, and prickling. It is localized to the dorsolateral aspects of the bilateral upper arms, forearms, and shoulders. Scratching is reported to make the discomfort worse, and many patients find that the only therapy that brings relief is the application of ice packs or cold, wet towels.[3, 8, 22] The discomfort is typically worse at night and, for some patients, may interfere with falling asleep.[4] The median duration of symptoms has been reported as 4.5 years,[2] but patients have reported a continuation of symptoms from this condition for as long as 18 years.[1] Rarely, patients may initially experience symptoms typical of brachioradial pruritus, followed by the onset of generalized pruritus.[33]

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Physical

Despite the severity of symptoms, no associated erythema or skin eruption is seen. Evidence of excoriation or lichenification may be present in the affected areas.

Altered sensation to pinprick and temperature in the distribution of the posterior cutaneous nerve of the forearm, which supplies the skin over the proximal brachioradialis muscle, may be observed.[7] Pronounced heat hyperalgesia in the C5 and C6 dermatomal distribution[8] and pinprick hyperesthesia in the C5-C8 distribution[9] may be seen.

Area of pruritus demarcated in pen in a middle-ageArea of pruritus demarcated in pen in a middle-aged woman with brachioradial pruritus. Macroscopically, no skin changes are visible.
Subtle excoriations on the dorsal forearm of a midSubtle excoriations on the dorsal forearm of a middle-aged woman with brachioradial pruritus.
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Causes

Exposure of the affected areas to sun and wind may precipitate an episode, as may radiculopathy of the cervical spine. These are speculative, and the authors believe the etiology is multifactorial. In some cases, an emotional component to the symptoms seems apparent.

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Complications

Psychiatric symptoms (eg, anxiety, depression) may develop over time in patients with unremitting symptoms. The intense tingling, burning, and itching associated with the disease often keeps patients awake at night.[4] Frustration from a lack of relief of symptoms with conventional antipruritis agents is common.

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Contributor Information and Disclosures
Author

Julianne Mann, MD Assistant Professor, Department of Dermatology, Oregon Health and Science University School of Medicine

Julianne Mann, MD is a member of the following medical societies: Alpha Omega Alpha, Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

David J Elpern, MD Consulting Staff, The Skin Clinic

David J Elpern, MD is a member of the following medical societies: American Academy of Dermatology, Hawaii Medical Association

Disclosure: Nothing to disclose.

Britton R Mann, DAOM, Dipl OM, LAc Private Practitioner in Acupuncture and Chinese Herbal Medicine, Metolius Natural Medicine

Britton R Mann, DAOM, Dipl OM, LAc is a member of the following medical societies: Pain Society of Oregon, Oregon Association of Acupuncture and Oriental Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Jacek C Szepietowski, MD, PhD Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Received consulting fee from Orfagen for consulting; Received consulting fee from Maruho for consulting; Received consulting fee from Astellas for consulting; Received consulting fee from Abbott for consulting; Received consulting fee from Leo Pharma for consulting; Received consulting fee from Biogenoma for consulting; Received honoraria from Janssen for speaking and teaching; Received honoraria from Medac for speaking and teaching; Received consulting fee from Dignity Sciences for consulting; .

References
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Area of pruritus demarcated in pen in a middle-aged woman with brachioradial pruritus. Macroscopically, no skin changes are visible.
Subtle excoriations on the dorsal forearm of a middle-aged woman with brachioradial pruritus.
 
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